The overall objective of this proposal is to refine and evaluate the proposed growth-immune support-nutrition-interaction (GINI) model as an approach to clinical description and monitoring of HIV exposed infants in home care programs. The specific research aims of this proposal are: (1) to evaluate, select, pilot test, and possibly modify existing data collection instruments which measure the growth and the interaction dimensions of infants cared for at home; (2) to describe the influence of the four factors in the model (growth, immune support, nutrition, and interaction) on each other and on the longitudinal progression of HIV disease and perinatally exposed infants in a home care program; and (3) to evaluate the GINI theoretical model as a guide for public health nursing visits during the first year of life in a cohort of infants exposed perinatally to HIV infection. Methodological studies are undertaken to establish reliability, validity, and feasibility of instruments for measuring child weight and length, and for caregiver-child interactions. The results of the these studies will be used to select instrumentation for a longitudinal involved prospective monitoring of HIV-exposed children in establishing Home Care programs. Patterns will be identify for the GINI variables during the first year of life and compared to children who are truly infected, seroreverters, and a comparison group of infants without perinatal HIV exposure. Nurses who use the model as the basis for assessment of HIV-exposed infants in the home will rate its utility. Training in design and advanced statistics that is accomplished in the first months of the award will be applied to the implementation and analysis of the prospective study in the subsequent months and years. The work will serve as a basis for future study of interventions appropriate to home care settings that will improve the quality of life and delay the impact of disease in HIV exposed and HIV infected infants and children living at home.